| NPI | 1780878314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M12065) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019824) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 7152301-1205) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 7152301-8905) | |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2018-01-10 |