| NPI | 1861716730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101257807) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: N/A Medical Student) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2015-07-01 |