| NPI | 1386208882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101285518) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0103557) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD60003656) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2025-04-28 |