| NPI | 1659861615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: NC 202303496) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2021001821) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2019011874) | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2024-03-04 |