| NPI | 1811287816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 58155) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2016-01080) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 29941) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-39828) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2022-07-21 |