| NPI | 1861608770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: AZ 60164) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA A129519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7335) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX M7335) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2022-07-06 |