| NPI | 1720242365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0009120) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: PA MT193775) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193775) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2010-02-16 |