| NPI | 1548469372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 47752) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 116019501) |
| 174400000X Specialist (Licence: AZ 47752) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2014-07-10 |