NPI | 1316226319 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 47501) |
Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: TN 55775) |
Enumeration Date | 2011-08-08 |
Last Update Date | 2022-04-06 |