| NPI | 1265643332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 258760) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT188246) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: NC 2015-00834) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2021-10-07 |