NPI | 1801152004 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD460620) |
Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD460620) |
Enumeration Date | 2012-04-02 |
Last Update Date | 2023-08-30 |