| NPI | 1225052467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: VA 0102202652) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102202652) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-10-26 |