| NPI | 1609404243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD61314952) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61314952) |
| 2085N0904X (Licence: WA MD61314952) | |
| 207U00000X Nuclear Medicine (Licence: WA MD61314952) | |
| 208000000X Pediatrics (Licence: WA MD61314952) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2026-03-18 |