| NPI | 1982990131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MI 4301101337) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2018-02-14 |