| NPI | 1225158702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301087330) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-00364) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301087330) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2011-03-25 |