| NPI | 1053512889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME108907) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085N0904X Radiology, Nuclear Radiology (Licence: FL ME108907) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2016-08-15 |