| NPI | 1447590245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 73386) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 303933) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2025-07-09 |