| NPI | 1003074352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME104296) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35091450) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 104296) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2012-08-06 |