| NPI | 1669979878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 149444) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL 149444) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-10-10 |