| NPI | 1821258203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX N5845) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2024015115) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2024-05-31 |