| NPI | 1386128643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A185850) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: NC 239820) |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2026-09-14 |