| NPI | 1972876340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: NY 282239) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA mt200704) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2021-04-27 |