| NPI | 1578925632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: NY 316406) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 221151324) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2024-05-09 |