| NPI | 1811239296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2013020362) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: KS 04-45862) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2025-12-18 |