| NPI | 1851565006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: UT 7030690-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-10390) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: UT 7030690-1205) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2024-01-30 |