| NPI | 1548729783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: TX W3545) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2026-04-02 |