| NPI | 1104130541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: TX BP10077411) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 61779) |
| 207R00000X Internal Medicine (Licence: PA MT211571) | |
| 363A00000X Physician Assistant (Licence: VA 0110003559) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2021-09-01 |