| NPI | 1598295776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: NY 333131) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 333131) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT224932) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-02-11 |