| NPI | 1093196099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PA OS020557) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 032.0134312) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: VT 032.0134312) | |
| 207R00000X Internal Medicine (Licence: PA OT016682) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: PA OT016682) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2026-05-14 |