| NPI | 1255320339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 318405) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.093102) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2022-07-25 |