| NPI | 1205000114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD466437) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 122366) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2024-12-17 |