| NPI | 1841483419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: AR E-6032) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-6032) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2009-07-27 |