| NPI | 1740456458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 072212) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: TX P7239) | |
| 2085B0100X Radiology Body Imaging (Licence: TX P7239) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX P7239) | |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2016-03-03 |