| NPI | 1700150406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101271551) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 74660) |
| 208D00000X General Practice (Licence: NE 27473) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2023-09-22 |