| NPI | 1871559229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: CA G32909) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: CA G32909) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA G32909) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: CA G32909) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-04-08 |