| NPI | 1679740302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME114899) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 260585) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2024-09-19 |