| NPI | 1184993776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL OS14534) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 5190) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO2767) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 39072) | |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2017-07-13 |