| NPI | 1487897153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T1954) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 131703) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDR.0001157) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2026-06-08 |