| NPI | 1497928204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 047567) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CT 047567) |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2014-06-20 |