| NPI | 1407344906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01897) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 239192) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2023-06-21 |