| NPI | 1770997652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 294215) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 260758) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 294215) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-04-01 |