| NPI | 1801215009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD467296) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: TX W5064) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2026-07-14 |