| NPI | 1740489350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: NC 312296) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA C166708) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 56242) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.086097) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C166708) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2022-12-07 |