| NPI | 1346688181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C209869) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61635648) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CA C209869) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD61635648) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2026-06-08 |