| NPI | 1700204427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: OK 5831) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: TX S0584) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S0584) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2022-09-30 |