| NPI | 1104454404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 9033) |
| Additional Taxonomies | 2085N0700X (Licence: VT 031.0133591) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM DO2025-0030) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 390200000X) | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-06-20 |