| NPI | 1588329437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 320033) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P111170) |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2023-07-14 |