| NPI | 1508429192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 69067) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CT 69067) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: CT 69067) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2021-09-10 |