| NPI | 1700073640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.205341) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 252697) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 920744) | |
| Enumeration Date | 2007-09-25 |
| Last Update Date | 2012-12-12 |