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 |