| NPI | 1376748343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: AZ 38193) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 38193) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2002010819) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: AZ 38193) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2018-01-18 |