| NPI | 1669607818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME157823) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL HSE# 11889) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2022-07-21 |