| NPI | 1790853554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 195281) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD 20050476) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2009-08-31 |