| NPI | 1457565806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: NC 2009-00679) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 111025) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2026-06-17 |