| 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 |