| NPI | 1679740302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL me114899) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 260585) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2026-03-03 |