| NPI | 1063409704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME20268) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: FL ME20268) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2017-11-29 |