| NPI | 1306045596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 050778) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C7-0004007) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0009080) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT191109) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2022-02-01 |