| NPI | 1467745661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.133505) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301111657) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 1467745661) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2018-06-22 |