| NPI | 1154716538 |
|---|---|
| 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: CT 83009) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2025-09-17 |