| NPI | 1811214133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 073829) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 1811214133) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2019-05-06 |