| NPI | 1982820676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A103663) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A103663) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2018-01-03 |