| NPI | 1114272523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: PA MD460469) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MD460469) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-9325) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2022-07-21 |