| NPI | 1992118806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 21638) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.127269) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME138621) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2024-02-09 |