| NPI | 1578880308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 75539) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 32325) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2016-06-22 |