| NPI | 1497140255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME168561) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 283537) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301118973) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2025-10-27 |