| NPI | 1639529910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD24354) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT211183) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2024-06-17 |