| NPI | 1447613005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2259) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH RT3081) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2026-01-26 |