| NPI | 1861874646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S5835) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: WI 71222) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: WI 71222) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 71222) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2020-04-29 |