| NPI | 1043296403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: UT 4839630-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44948) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2023-08-23 |