| NPI | 1831351113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N3560) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10031163) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 75-2934-01) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2016-04-28 |