| NPI | 1568647253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 49896) |
| Additional Taxonomies | 2085N0700X (Licence: AZ 49896) |
| Enumeration Date | 2008-01-01 |
| Last Update Date | 2025-07-22 |