| NPI | 1063774776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD460148) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA10344700) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT202281) | |
| Enumeration Date | 2012-06-10 |
| Last Update Date | 2018-05-11 |