NPI | 1316500937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME174871) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10067101) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX BP10067101) | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP20069820) | |
Enumeration Date | 2019-04-18 |
Last Update Date | 2025-07-11 |