| NPI | 1235791534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MD D97065) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2019018775) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2023-08-31 |