| NPI | 1588926455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: FL ME134624) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116024785) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2018-03-17 |