| NPI | 1861782195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: UT 13128741-1205) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: PA MT207936) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME127877) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2023-10-22 |