| NPI | 1922353689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 290509-01) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: NY Pending) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2023-09-26 |