| NPI | 1033778329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME158202) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN29154) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN29154) | |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2022-09-06 |