| NPI | 1568090009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: KY 60751) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-10-08 |