| NPI | 1356329148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MA 151802) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 151802) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 151802) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2024-05-14 |