| NPI | 1386938587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R0400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200098) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200098) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2017-02-08 |