| NPI | 1053816868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 304588) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 304588) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-10-04 |