| NPI | 1639515034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 58702) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103802) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103802) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2020-08-12 |