| NPI | 1962197442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 029847) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 029847) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-17 |