| NPI | 1407167646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S5911) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S4911) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S4911) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S5911) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2022-08-10 |