| NPI | 1427408806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD61174409) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61174409) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61174409) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2023-09-28 |