| NPI | 1396053666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61309353) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA OP61309353) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2022-08-25 |