| NPI | 1740660539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 308280) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2015017144) |
| 363A00000X Physician Assistant (Licence: NY 308280) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-07-07 |