| NPI | 1659536233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 260295) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: NY 260295) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2023-08-14 |