| NPI | 1821354689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0067347) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 2491) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 14209A) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX R0535) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2022-02-03 |