| NPI | 1548234933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 038237) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: TN 61912) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: GA 038237) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2024-01-12 |