| NPI | 1275828212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME123598) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: WI 55874) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2015-06-11 |