| NPI | 1053639484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 56282) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 277475) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2022-01-11 |