| NPI | 1609542539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-12340) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA R-12026) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: IA R-13011) | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-07-24 |