| NPI | 1477718377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 53957-020) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI L2511673) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2018-12-13 |