NPI | 1568985992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 316402) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 33233) |
363AM0700X Physician Assistant, Medical (Licence: NY 316402) | |
Enumeration Date | 2017-07-18 |
Last Update Date | 2023-07-17 |