| NPI | 1568181667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0109542118) |
| 2085B0100X Radiology, Body Imaging (Licence: NY P114929) | |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2025-07-20 |