| NPI | 1710120365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 073242) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085B0100X Radiology, Body Imaging (Licence: TN 48451) | |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2015-05-01 |