| NPI | 1356504609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0437302) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116020750) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52210) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2014-08-05 |