| NPI | 1013231570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD14660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI CLP01678) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2021-04-06 |