| NPI | 1235627118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101282635) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL MD.49143) |
| 208D00000X General Practice (Licence: NC 20192400) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2024-07-17 |