| NPI | 1710273511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD456896) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD042081) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA mt199892) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2022-07-21 |