| NPI | 1982870283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: UT 8125153-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 8125153-1205) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2023-08-23 |