| NPI | 1700261500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: FL ME139515) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: IA R-10175) |
| 2085P0229X Radiology Pediatric Radiology (Licence: DE C1-0013054) | |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2020-09-22 |