| NPI | 1811123433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-04872) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 64809) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020012800) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2024-01-09 |