| NPI | 1932562683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX T9663) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD18691) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC MD85442) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-09-08 |