| NPI | 1184742389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 43524) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301081574) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101245669) | |
| 2085B0100X Radiology Body Imaging (Licence: KY 42892) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2012-12-19 |