| NPI | 1376991869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101274699) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: NC 2021-02067) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD469163) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-02067) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT211009) | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2023-04-11 |