| NPI | 1356755573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: SC 38234) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 70879-20) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 259908) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2021-05-20 |