| NPI | 1336128461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 37336) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 37162) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2019-03-04 |