| NPI | 1700339504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C1-0012542) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: PA MT210275) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CA C195551) | |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2024-08-26 |