| NPI | 1922369024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MA 262589) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MD D0101839) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0101839) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2025-04-22 |