| NPI | 1073177036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2026-03398) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2026-06-11 |