| NPI | 1326862392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WA TR70045173) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA TR70045173) |
| Enumeration Date | 2024-11-14 |
| Last Update Date | 2026-01-06 |