| NPI | 1285841130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-01137) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 182390) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME109476) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018770) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-07-03 |