| NPI | 1679005888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD26929) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 76963) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-07-03 |