| NPI | 1356556112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2010015949) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KS 04-34288) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-12-18 |