| NPI | 1174844401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 39011) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81252) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2023-01-11 |