| NPI | 1104188077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463556) |
| Additional Taxonomies | 2085N0700X (Licence: MD D0079989) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0079989) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116024813) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2025-04-22 |