| NPI | 1275816365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT208783) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 57276) |
| Enumeration Date | 2011-09-24 |
| Last Update Date | 2015-06-29 |