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 |