| NPI | 1043531643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A141600) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX bp10037229) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 50148) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2016-04-25 |