| NPI | 1952411779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: WI 47272) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD00046543) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-03-12 |