| NPI | 1518350594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CO DR.0061915) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 61915) |
| Enumeration Date | 2015-03-14 |
| Last Update Date | 2023-08-14 |