| NPI | 1740268077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME120711) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C10011071) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX L9429) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-09-15 |