| NPI | 1912939109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A94986) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A94986) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-07-10 |