| NPI | 1508817032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C1-0012739) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD420248) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD420248) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2023-03-07 |