| NPI | 1831212307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35121403) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: OH 35121403) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301088488) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2021-12-27 |