| NPI | 1699921627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: CA C183038) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 036.120499) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 53818) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA C183038) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0069419) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2024-04-08 |