| NPI | 1346496528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2017002989) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017002989) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-39843) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KS 04-39843) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2022-07-21 |