NPI | 1477787539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD61676594) |
Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61676594) |
2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61676594) | |
Enumeration Date | 2009-05-05 |
Last Update Date | 2025-09-09 |