| NPI | 1275658734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60071506) |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: MI 4301083789) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200800524) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083789) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2016-12-22 |