| NPI | 1679943336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: CA A170861) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A170861) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2024-04-05 |