| NPI | 1629365275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301099444) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 302568) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301099444) | |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2022-12-20 |