| NPI | 1649254640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 41001) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NC 33608) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 41001) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2018-01-23 |