| NPI | 1063946580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 321827) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 92459) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2023-05-16 |