| NPI | 1790071561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD480154) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 272334) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2024-05-22 |