| NPI | 1184152704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: KY 56868) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R4504) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2023-05-25 |