| NPI | 1316265960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35125760) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT196776) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2017-05-30 |