| NPI | 1417931502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101237227) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: VA 0101237227) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2014-02-07 |