| NPI | 1619276888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301100186) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 201700969) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2022-10-20 |