| NPI | 1083143630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0025871) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt-214328) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-10-06 |