| NPI | 1568102408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL200001535) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2026-01797) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2026-07-21 |