| NPI | 1962585125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA C158388) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 31819) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C158388) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-11-19 |