| NPI | 1255950390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: UT 14211357-1205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD70011784) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2025-09-11 |