| NPI | 1063395994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: DE C7-0018679) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL 41417) |
| Enumeration Date | 2025-07-29 |
| Last Update Date | 2025-07-29 |