| NPI | 1437686201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD67813) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 010029533) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301506546) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-10-04 |