| NPI | 1063888345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MN 69917) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CO DR.0070390) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 05514) | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2024-09-09 |