| NPI | 1982749644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0016117) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 221070) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101249547) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 264576) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2022-08-26 |