| NPI | 1447631536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT209701) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MT209701) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT209701) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-06-22 |