| NPI | 1093766354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C10004138) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C10004138) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD019886E) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: NJ MA06748500) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2011-09-26 |