| NPI | 1881850097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: TX T1216) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 53385 - 20) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2021-08-18 |