| NPI | 1245718576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX V6035) |
| Additional Taxonomies | 2085N0700X (Licence: AR E-13321) |
| 2085N0700X (Licence: MA 277033) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6035) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2025-03-18 |