| NPI | 1376030825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 69345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-67472) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2023-11-02 |