| NPI | 1508212127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 010265) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64020) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 94-10030) | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2023-10-11 |