| NPI | 1548655343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 38598) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 28866) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-05-30 |