| NPI | 1578805974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 277597) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 63595) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2019-09-25 |