| NPI | 1306126222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME123437) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NJ 25MA10120700) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2024-04-11 |