| NPI | 1134758162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 14137811-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.148123) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-09-16 |