| NPI | 1427645886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 77626) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 77626) |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2024-09-10 |