| NPI | 1104280478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 65302) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 29924) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: TN 65302) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-04-03 |