| NPI | 1942401682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME146126) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: LA 332133) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.094264) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-11-15 |