| NPI | 1760865984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2020018875) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 31640) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2021-03-22 |