| NPI | 1306054903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: MA 238856) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: LA MD.204011) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA mt184848) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2025-07-31 |