| NPI | 1215314323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 70045) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.142470) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 55231) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.142470) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2024-03-10 |