| NPI | 1649565821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 5761) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT014362) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2020-06-05 |