| NPI | 1831402635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT207536) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI L1553542) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2025-11-17 |