| NPI | 1033501416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-05590) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA 559YY0231) |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: IA R-11758) | |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2021-05-06 |