| NPI | 1609138916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R6518) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 52930) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX bp10044003) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2021-11-16 |