| NPI | 1467529701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 052032) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CT 052032) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 221631) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-09-26 |