| NPI | 1174532048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301072516) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301072516) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MI 4301072516) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2015-12-10 |