| NPI | 1568449239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 26361) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MN 26361) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2012-02-29 |