| NPI | 1609405919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0904X Radiology, Nuclear Radiology (Licence: FL ME159687) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2023-02-19 |