| NPI | 1396169694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: NE 28853) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28853) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2020-10-21 |