| NPI | 1730529306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD16159) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY FR0435669392) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 08274169) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2019-03-14 |