| NPI | 1801100367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 54172) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 4692) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO 201101547) | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2015-06-04 |