NPI | 1568572832 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C54827) |
Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA C54827) |
2085P0229X Radiology, Pediatric Radiology (Licence: CA C54827) | |
Enumeration Date | 2006-08-30 |
Last Update Date | 2012-08-06 |