| NPI | 1992707145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 037976) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 37976) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: GA 37976) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 22152) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2019-10-21 |