| NPI | 1710975669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 26149) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: IA 26149) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2007-12-11 |