| NPI | 1164876363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0070140) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 10483051-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG178761) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2023-05-09 |