| NPI | 1083931455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CO DR.0051251) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD438966) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 51251) | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2018-11-17 |