| NPI | 1306072798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME123715) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME123715) |
| 208600000X Surgery (Licence: FL TRN13983) | |
| Enumeration Date | 2009-05-31 |
| Last Update Date | 2022-09-07 |