| NPI | 1386865665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2011-00827) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 141121) |
| 207R00000X Internal Medicine (Licence: NC 141121) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2013-02-28 |