| NPI | 1588102164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U0391) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102205623) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2023-08-01 |