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 |