| NPI | 1144489667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: SC 96790) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2008-0207) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2015-01706) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2026-07-24 |