| NPI | 1417184342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: NJ 25MA09531400) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0011320) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD455296) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2019-09-09 |