| NPI | 1083078836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S7845) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 89239) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2024-06-21 |