NPI | 1235315052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200900402) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 141515) |
Enumeration Date | 2008-01-10 |
Last Update Date | 2015-09-06 |