| NPI | 1053730747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: MA 277648) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 60282018) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2019-06-21 |