| NPI | 1861607665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA C175409) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 20120628) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME142200) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2012020608) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KS 04-36279) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME142200) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2026-01-30 |