| NPI | 1790975019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL me117332) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085N0700X Radiology, Neuroradiology (Licence: LA MD.202487) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2014-03-17 |