| NPI | 1922271873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 50697) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 31674) | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2015-03-13 |