| NPI | 1346460367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101240781) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 46706) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21303) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018271) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-07-06 |