| NPI | 1619175890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C195815) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA C195815) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD445798) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX P8785) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CA C195815) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2024-08-13 |