| NPI | 1770216798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 77750) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 328880) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY P105276) | |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2024-05-29 |