| NPI | 1497721146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD418526) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: VA 0101040755) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101040755) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2025-03-03 |