| NPI | 1578768131 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085N0700X (Licence: MN 79257) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 60302-20) | 
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090426) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-15 | 
| Last Update Date | 2025-08-27 |