| NPI | 1558565762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: ND 11490) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 11490) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2004015303) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-11-23 |