| NPI | 1851596654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301109188) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2006016529) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101249118) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY 47873) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: MI 4301109188) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2016-06-13 |