| NPI | 1043448103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R5584) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 31.126652) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2018-09-06 |