| NPI | 1922111020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 84288) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME 116578) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME116578) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2026-01-27 |