| NPI | 1356970677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0067266) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: CO DR.0067266) | |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2026-03-27 |