| NPI | 1437197654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 077071) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MA 207894) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 077071) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2016-12-20 |