| NPI | 1841433943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 54595) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD458618) |
| 2085N0700X Radiology, Neuroradiology (Licence: PA MD458618) | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2022-03-30 |