| NPI | 1790947943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65916) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 43594) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60864) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2016-09-06 |