| NPI | 1720168610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MI 4301044848) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301044848) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301044848) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2012-05-31 |