| NPI | 1760695761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A99832) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 56825) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CA A99832) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0068161) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2024-04-15 |