| NPI | 1568081057 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 63618) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1022072) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-14 | 
| Last Update Date | 2025-08-25 |