| NPI | 1942461009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME115128) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193506) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 004043) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 69415) | |
| Enumeration Date | 2008-06-21 |
| Last Update Date | 2016-04-11 |