| NPI | 1215986948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2005032730) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: TN 4178) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX M1770) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2005032730) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M1770) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 4178) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2023-01-25 |