| NPI | 1487926341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 147230-1205) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: UT 147230-1305) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2012-02-07 |