| NPI | 1962677229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: NY 272207-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 272207-01) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2023-12-22 |