| NPI | 1811225394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: NY 257302) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY xxxxxxx) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: NY 257302) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 257302) | |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 257302) | |
| Enumeration Date | 2009-11-22 |
| Last Update Date | 2018-09-20 |