| NPI | 1477814119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: NY 292087) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT201857) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2018-05-02 |