| NPI | 1497164909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: TN 0000003661) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2019-05-14 |