| NPI | 1053475301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 53496) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KY TP902) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2013045372) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2013045372) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-08-10 |