| NPI | 1609901610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: UT 8209945-1205) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: ID M-11694) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MT MED-PHYS-LIC-52597) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2023-08-23 |