| NPI | 1730404757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 39170) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 005020) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2016-11-02 |