| NPI | 1902165533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101262299) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66958) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63177) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2022-06-20 |