| NPI | 1710392949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD474293) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC LL37200) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-06-21 |