| NPI | 1457774895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD477853) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD H-500-603-492-417) |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2022-12-05 |