| NPI | 1063286763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: TX 448544) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10086595) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 448544) | |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2024-11-20 |