| NPI | 1558444778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G73461) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA G73461) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: DC MD035867) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD461178) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-12-02 |