| NPI | 1164905147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 93327) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 11263) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085N0700X (Licence: GA 93327) | |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2026-06-06 |