| NPI | 1164084836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME156715) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 0000) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-08-27 |