| NPI | 1407319064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 21244) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024027488) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2487) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-09-23 |