| NPI | 1306951579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TN MD46275) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: WA TR00046102) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2022-03-31 |