| NPI | 1821125287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 247221) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA L-229339) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2012-07-19 |