| NPI | 1235395641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME123523) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 54379) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2023-11-30 |