| NPI | 1730635483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 033903) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1484) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2026-04-14 |