| NPI | 1619380359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD469828) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MA 278681) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2020-09-30 |