| NPI | 1215498241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 339528) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 29214) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2024-07-30 |