| NPI | 1245426790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6456) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 37420) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX M6456) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2022-01-25 |