| NPI | 1881863827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 43886) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301091732) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN11923) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2012-10-25 |