| NPI | 1972063477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0018721) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 338025) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2025-09-25 |