| NPI | 1205848157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60028876) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA ML20008465) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2008-09-25 |