| NPI | 1063874808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 71039) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 54624) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-08-22 |