| NPI | 1386024354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME150849) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CO TL.0008299) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0008299) | |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2021-07-15 |