| NPI | 1881617322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301070195) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301070195) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MI 4301070195) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2018-06-05 |