| NPI | 1407312234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101271354) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101271354) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2024-06-05 |