| NPI | 1891959466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 259417) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 048857) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08361000) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 53067-020) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2010-12-08 |