| NPI | 1265688048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology Diagnostic Neuroimaging (Licence: VA 0101245259) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0068699) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2022-11-29 |