| NPI | 1881394484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA A200782) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A200782) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA 11143) | |
| 2085N0904X (Licence: CA A200782) | |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2026-08-04 |