| NPI | 1225442544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 291819-01) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT206198) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD474959) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2022-01-25 |