| NPI | 1407149768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 71801) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 183028) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2022-08-03 |