| NPI | 1003378829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 86084) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 80386) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2026-07-03 |