| NPI | 1306401708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207U00000X Nuclear Medicine (Licence: MN 76376) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2024-04-23 |