| NPI | 1376527382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: WA MD61563178) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61563178) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61563178) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2025-08-05 |