| NPI | 1245687540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T1391) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 40843) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL40843) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2022-10-03 |