| NPI | 1134680705 |
|---|---|
| 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: MS 32346) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: LA 339239) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-02-14 |