| NPI | 1568562395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S7047) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 25276) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: OK 25276) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-07-28 |