| NPI | 1790995207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX P1072) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 096808) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2012-08-21 |