| NPI | 1104017250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD201126) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 201126) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0070851) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2017-04-25 |