| NPI | 1609135177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME135139) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 056073) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD14738) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT201214) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2018-08-15 |