| NPI | 1467075606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-02257) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL84115) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL21-0850) | |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2026-06-30 |