| NPI | 1871875260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PR 19366) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT210198) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 19366) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PR 19366) | |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2018-08-10 |