| NPI | 1679014930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101274995) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 295488) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2024-10-04 |