| NPI | 1962405753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: CA G75723) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 29598) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G75723) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2024-04-08 |