| NPI | 1275111916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 323813) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-08-19 |