| NPI | 1205268455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: SD 1140011400) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MN 63521) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 12075A) | |
| 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: WY 12075A) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 1140011400) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 63521) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 25474) | |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2020-01-14 |