| NPI | 1972845519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 28086) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28086) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S8420) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2026-01-05 |