| NPI | 1518587351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE TEP9013) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-11882) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2021-07-26 |