| NPI | 1205925864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 25546) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A97272) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A97272) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 44935) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-06-24 |