| NPI | 1932555885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S9968) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 325894) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI DOS-3021) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2026-09-30 |