| NPI | 1598991762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 630272) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MT 6962) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2009-06-02 |