| NPI | 1023202611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C7-0003672) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD433905) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: DE C1-0008916) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT192173) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2012-01-18 |