| NPI | 1558550608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX Q1742) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57013269) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q1742) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2022-06-10 |