| NPI | 1649383027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: UT 11765834-1205) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KS 04-33446) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2008036902) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-08-18 |