| NPI | 1780655795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 56469) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CO 0068036) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: HI MD-10172) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-10172) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2023-08-24 |