| NPI | 1891832184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0102202327) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: VA 0102202327) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: HI DOS-879) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2014-02-07 |