NPI | 1073068748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0109542100) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116028905) |
Enumeration Date | 2016-08-23 |
Last Update Date | 2021-07-30 |