| NPI | 1588617674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MO R7C80) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R7C80) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2022-08-16 |