| NPI | 1568623569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2014-01064) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: FL ME115630) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2020-12-03 |