| NPI | 1457542631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD441379) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: TX BP1-0028963) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2010-10-21 |