| NPI | 1285139550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 125.073519) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 125.073519) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2019-06-27 |