| NPI | 1316366776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 59964) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-02231) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 83804) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 0) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2019-11-05 |