| NPI | 1295090587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME150683) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 18975) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2021-08-02 |