| NPI | 1033366463 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 45805) | 
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: AR E-18006) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-18006) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45805) | |
| Enumeration Date | 2008-08-27 | 
| Last Update Date | 2024-09-25 |