| NPI | 1780861286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME103993) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD433283) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD433283) | |
| 2085N0700X Radiology, Neuroradiology (Licence: FL ME103993) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2012-08-06 |