| NPI | 1366480634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A96070) |
| Additional Taxonomies | 2085N0700X (Licence: CA A96070) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2026-09-29 |