| NPI | 1992125108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2019-01094) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 249951) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-27 |
| Last Update Date | 2020-10-28 |