| NPI | 1073176616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 66072) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 83077) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 105671) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2025-10-09 |