| NPI | 1730166208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A84821) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MN 24646) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2016-02-23 |