| NPI | 1770787830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6673) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M6673) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2025-12-15 |