| NPI | 1033283353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 15082R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A63909) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME165254) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2024-01-19 |