| NPI | 1871584458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: AZ 6344) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 06344) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-08 |