| NPI | 1417512005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 202069) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG193629) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 67694) | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2026-09-22 |