| NPI | 1669784864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 52696) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q8035) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10052216) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.018589) | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2021-12-02 |