| NPI | 1346688181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA IMLC.MD.61635648) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: WA IMLC.MD.61635648) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2026-10-08 |