| NPI | 1104267525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME149129) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: GA 82954) |
| 2085N0700X Radiology, Neuroradiology (Licence: GA 82954) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-14 |
| Last Update Date | 2023-01-13 |