| NPI | 1255567947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 12974760-1205) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: MO 2019039191) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2019039191) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2025-09-04 |