NPI | 1063689776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NC 2010-00981) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 128001) |
Enumeration Date | 2008-05-12 |
Last Update Date | 2012-03-01 |