| NPI | 1881000149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME145132) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54391) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN20203) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2023-01-09 |