| NPI | 1235578980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 580963) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 274627) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2018-06-13 |