| NPI | 1275207664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX 47655) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 47655) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2022-07-15 |