NPI | 1699064196 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 202302765) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-53573) |
2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-255) | |
2085R0204X Radiology, Vascular & Interventional Radiology (Licence: FL ME131503) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2011-04-05 |
Last Update Date | 2024-12-17 |