| NPI | 1588059471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35141674) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 267962) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 267962) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-03-26 |