| NPI | 1265827224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NY 310483) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 310483) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2023-07-07 |