| NPI | 1912905563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0051600) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MD D0051600) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: DC MD33346) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2019-07-12 |