| NPI | 1114486057 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 6178) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2019-03-19 | 
| Last Update Date | 2025-10-08 |