| NPI | 1134579675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 318332) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 290143) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2023-09-20 |