| NPI | 1023308541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 83179) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5561) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD176369) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101262730) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2020-04-15 |