| NPI | 1235499229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 55725) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S1636) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2019-07-15 |