| NPI | 1497964910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC DO36671) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS34309) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2013-00495) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2016-01-13 |