| NPI | 1538162953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MD D96115) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AZ 38022) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 38022) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 38022) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J9359) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-01-19 |