| NPI | 1255027165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102209926) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 113107) | |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-09-17 |