| NPI | 1538516570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: CA A191209) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 288465) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A191209) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2024-04-08 |