| NPI | 1235365347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: NC 201500967) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT195587) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2021-02-09 |