| NPI | 1982964458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 2014-01721) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182449) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2021-02-09 |