| NPI | 1518319458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 65197) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.028463 - Ack) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2022-07-26 |