| NPI | 1720242308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: KY C2962) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090697) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2024-12-20 |