| NPI | 1619932894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: NY 315370) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME82697) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2022-09-08 |