| NPI | 1326428160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 38295) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC LL38295) |
| Enumeration Date | 2015-06-07 |
| Last Update Date | 2021-07-16 |