| NPI | 1508393901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 97215) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 71607) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2023-10-13 |