| NPI | 1487934584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 53392) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 322304) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA Intern) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT210265) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2020-06-17 |