| NPI | 1124006747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: VA 0101027809) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101027809) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-07-08 |