| NPI | 1629234711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301106142) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085N0700X Radiology, Neuroradiology (Licence: MI 4301106142) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2014-07-08 |