| NPI | 1720399629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10038246) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 262077) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2015-05-26 |