| NPI | 1962898502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0070553) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0102204811) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX S7824) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2024-01-09 |