| NPI | 1629508197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 010146) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: RI DO01156) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-07-13 |