| NPI | 1558335695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA G86073) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G86073) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2026-09-29 |