| NPI | 1639603624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2025-0395) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 336377) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085N0700X (Licence: LA 336377) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT217684) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2025-04-11 |