| NPI | 1023013380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AL 00025917) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W4490) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX W4490) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2026-03-23 |