| NPI | 1245761204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 34612) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 02061) |
| 208D00000X General Practice (Licence: PR 34612) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 022210) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2026-06-01 |