| NPI | 1215373634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: AZ 64037) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: WI 63171) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2024-04-15 |