| NPI | 1790887792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: LA 09172r) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.09172R) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2024-03-22 |