| NPI | 1518161017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD60292905) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: ID M-12322) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12322) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60292905) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2019-04-17 |