| NPI | 1124765839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT229675) |
| Enumeration Date | 2022-05-14 |
| Last Update Date | 2023-06-17 |