| NPI | 1215101894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: TX R8645) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R8645) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-8292) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: AR E-8292) | |
| 2085R0204X Radiology Vascular & Interventional Radiology (Licence: TX R8645) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2022-06-10 |