| NPI | 1902849508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TX M1613) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX FTL 40744) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M1613) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2025-10-08 |