| NPI | 1194112813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A20259) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2024015341) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2026-09-14 |