| NPI | 1790964773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 49614) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 52876) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA 4068) | |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2015-09-22 |