| NPI | 1578876496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 54326) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 105655) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2021-07-07 |