| NPI | 1144615576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 14192) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 148256) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2023-08-14 |