| NPI | 1861627796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MA 239721) |
| Additional Taxonomies | 282NC2000X General Acute Care Hospital, Children (Licence: MA 239721) |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2014-06-03 |