| NPI | 1528416526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD18551) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11018807A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 292930) | |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2022-07-12 |