| NPI | 1083279657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101281358) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT217497) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL005756) | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2024-07-01 |