NPI | 1225485634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: MI 4301508354) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-05-17 |
Last Update Date | 2024-07-16 |