| NPI | 1285128892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OS021997) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OT018664) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 91299) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2024-06-14 |