| NPI | 1164817235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NY 307445) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 307445) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2023-03-10 |