| NPI | 1487602058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 181671) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: NY 181671) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-07-05 |