| NPI | 1376805044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 48187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73452) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 48187) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2018-09-06 |