| NPI | 1912169384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61218975) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: UT 7471506-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD450662) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 172123) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 273359) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 7471506-1205) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116020753) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2022-07-15 |