| NPI | 1386268035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 81227) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351046529) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2025-06-30 |