| NPI | 1265793236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 86506) |
| Additional Taxonomies | 2085N0700X (Licence: GA 86506) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 86506) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2026-07-06 |