| NPI | 1528210879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: ND 12941) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND RL10952) |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2020-08-17 |