| NPI | 1558492124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO1608) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52263) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R0965) | |
| 2085N0700X Radiology, Neuroradiology (Licence: NY 257031) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2024-03-29 |