| NPI | 1679197693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 336686-01) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351046755) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351046755) | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2025-08-06 |