| NPI | 1437704608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME170835) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085N0700X (Licence: TX BP10069051) | |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2025-10-06 |