| NPI | 1871528224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WI 59024) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00044628) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 59024) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WI 59024) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-04-23 |