| NPI | 1992144752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 82323) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 0116026011) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2019-08-01 |