| NPI | 1134445364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 83086) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 279668-1) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 02637) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.003192) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2023-01-03 |