| NPI | 1952567315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 43026) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY AS0552489635) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2010-07-28 |