| NPI | 1053758524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: CA 20A16116) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: WA OP60938400) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA OP60938400) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0064893) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA 20A16116) | |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2024-04-04 |