| NPI | 1306401708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 76376) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: MN 76376) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2024-12-30 |