| NPI | 1316294655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q1475) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP1-0042926) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2025-12-04 |