| NPI | 1558688077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65759) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 105562) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 54646) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2020-10-27 |