| NPI | 1720361835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME143300) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C1-0013542) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME143300) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-9826) | |
| Enumeration Date | 2011-09-25 |
| Last Update Date | 2023-03-06 |