| NPI | 1487760302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD60726417) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N1237) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60726417) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-07-21 |