| NPI | 1609337294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 7879) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 7879) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2021-06-08 |