| NPI | 1396858106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: FL 99025) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: FL ME99029) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101240075) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL 99025) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: VA 0101240075) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2021-09-21 |