| NPI | 1427555903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC DO210012717) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 5497) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 339818) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A20512) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2026-04-23 |