| NPI | 1841583051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 273039) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT199689) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME128516) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199689) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2018-03-17 |