| NPI | 1497049647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301504006) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C1-0012173) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-07-15 |