| NPI | 1770675654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD026831E) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NJ MA07602300) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: PA MD026831E) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2013-04-18 |