| NPI | 1497919302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology, Radiation Oncology (Licence: NY 269349) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 269349) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2023-07-07 |