| NPI | 1306138128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 26908) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: NE 26908) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 26908) | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2023-07-14 |