| NPI | 1437356268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD60942783) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A99500) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A99500) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60942783) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2019-08-22 |