| NPI | 1679795538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101237479) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016844) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CT 047419) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 075962) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2018-08-20 |