| NPI | 1164898045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: PA MD464575) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P97183) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2019-10-22 |