| NPI | 1134515497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: TX T3010) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: PA MD470683) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T3010) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2023-04-21 |