| NPI | 1952693996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61383531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN15928) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL MD.34975) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN15928) | |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2024-08-29 |