| NPI | 1265757728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2016-00210) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 39167) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-28 |
| Last Update Date | 2017-12-20 |