| NPI | 1588862247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 287656) |
| Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: DC MD040481) |
| 2085P0229X Radiology Pediatric Radiology (Licence: VA 0101251674) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: MA 246860) | |
| 2085P0229X Radiology Pediatric Radiology (Licence: MD D0073964) | |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2018-03-17 |