| NPI | 1891757522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 056665) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 056665) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101009247) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2023-03-07 |