| NPI | 1487911103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463886) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A128894) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2018-05-21 |