| NPI | 1801829015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 180949) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 180949) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-07-22 |