| NPI | 1881987113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 275277) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301098578) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301098578) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2021-07-20 |