| NPI | 1346668191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 82868) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 82868) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2019-09-09 |