| NPI | 1053457721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: DC MD500003109) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 12603) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 214342) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2024-05-17 |