NPI | 1295090587 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME150683) |
Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 104146) |
2085R0202X Radiology, Diagnostic Radiology (Licence: PR 18975) | |
2085P0229X Radiology, Pediatric Radiology (Licence: VA 0101285826) | |
Enumeration Date | 2012-07-12 |
Last Update Date | 2025-09-16 |