| NPI | 1053750323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: FL ME144263) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: PA MD465719) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-08-03 |