| NPI | 1275644510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME93630) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: AL 24223) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AL 24223) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-01-15 |