| NPI | 1023452604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 68798) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 1023452604) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2018-06-11 |