| NPI | 1538546577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T6066) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 47303) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10052401) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2022-06-23 |