| NPI | 1003029620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101244104) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 70427) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116015745) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-04-07 |