| NPI | 1396066577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: TN 60891) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL-10921) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2020-06-11 |