| NPI | 1528097839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MN 30503) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 30503) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-08 |