| NPI | 1306400361 |
|---|---|
| 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: WA MD61470134) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 338842) | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2024-04-29 |