| NPI | 1336176973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2009022384) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OK 30184) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2013-08-20 |