| NPI | 1619366499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: PA MD472450) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210439) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2021-08-27 |