| NPI | 1750764445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 312074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 264706) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 264706) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-07-16 |