| NPI | 1750636411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: CA A154248) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: OH 35.130083) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX R8723) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2022-12-01 |