| NPI | 1376527382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 208196) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4244) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX M4244) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-07-21 |