| NPI | 1265606586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A110798) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA F5479 - 4866) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2018-12-11 |