| NPI | 1528479631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX 47681) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL 129212) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2023-06-06 |