| NPI | 1033506761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 287643) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 68063) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2021-08-27 |