| NPI | 1922291863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P6874) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000046171) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019816) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2020-08-04 |