| NPI | 1851590186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 062102) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT190055) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2012-10-23 |