| NPI | 1336320365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 205361) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: LA MD.205361) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2019-01-24 |