| NPI | 1700885712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 9801055) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NC 9801055) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0069830) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 23120) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2023-03-14 |