| NPI | 1942664594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01684) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CO DR.0065987) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2022-12-13 |