| NPI | 1699108779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AL 36739) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA PTAL) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36739) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2019-03-05 |