| NPI | 1568754521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 14013) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60468) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-9107) | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2016-08-08 |