| NPI | 1013278506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R7219) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO R7219) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO R7219) | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2012-05-31 |