| NPI | 1417303405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME165038) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 12215487-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2023-12-13 |