| NPI | 1578874277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 82203) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102209092) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 109820) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP60630438) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2025-09-16 |