| NPI | 1437654654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 95225) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 30094) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2023-06-25 |