| NPI | 1104183755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: VA 0101264312) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101264312) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA D0088425) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2022-02-04 |