| NPI | 1497047096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: AZ 53868) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: DE C1-0012759) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX BP10040578) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: NJ 25MA10383700) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: PA MD464892) | |
| Enumeration Date | 2011-05-14 |
| Last Update Date | 2022-07-21 |