| NPI | 1770069445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0018524) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 337435) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2025-11-28 |