| NPI | 1518937143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: SC 30321) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 30321) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 11731) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-05-06 |