| NPI | 1124552377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO5855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT017654) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL UO5855) | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2022-06-04 |