| NPI | 1477715597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 51743) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN12477) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0052333) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2023-11-01 |