| NPI | 1538514831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A181650) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: CA A181650) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2025-08-15 |