| NPI | 1407148968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63071) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 272697) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2018-12-20 |