| NPI | 1922216803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: VA 0109542050) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018596) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2013-01-21 |