| NPI | 1265964548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 331083) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 91576) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS T-3287) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2022-10-20 |