| NPI | 1336877968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P115193) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 332694) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2024-09-11 |