| NPI | 1750656864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 254714) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2014-02-28 |