| NPI | 1770931362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 63802) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY P07477) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2019-10-23 |