| NPI | 1467865444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: FL 150901) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT206890) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2021-08-09 |