| NPI | 1114389897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 315122-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT MED-PHYS-LIC-117675) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-05-31 |