| NPI | 1649603267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 67351) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 37217) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W4676) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2026-09-23 |