| NPI | 1922238278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 23854) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL R10157) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2017-11-03 |