| NPI | 1477787539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX Q5162) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 259675) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q5162) | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2022-06-10 |