| NPI | 1407279714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS16979) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 286233) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2023-04-05 |