| NPI | 1861805913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S8212) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 36662) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2026-02-02 |