| NPI | 1104117688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 24982) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: KY R2826) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R2826) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2022-07-21 |