| NPI | 1972708345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 83457) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101244742) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019717) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2022-12-07 |