| NPI | 1023570819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101286341) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 105680) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-10-03 |