| NPI | 1992052005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 300762) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252603) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2022-09-02 |