| NPI | 1134968449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC RTL25-1047) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: SC LL92120) | |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2025-06-20 |