| NPI | 1861655755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD461079) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: DC MD042160) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MD D0077752) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 250277) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101256011) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-07-21 |