| NPI | 1982801700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N6462) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM FELMD2020-019) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10028412) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2020-05-08 |