| NPI | 1265863013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G11173) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: CA G11173) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2013-12-04 |