| NPI | 1578919106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: FL OS17542) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2025-09-17 |