| NPI | 1407115892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME179125) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD462514) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101264497) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2026-06-24 |