| NPI | 1619968658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 75776) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 203672) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2025-04-29 |