| NPI | 1558522847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 261288) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 261288) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2023-07-07 |