| NPI | 1699127605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 68689) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL 14200) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2021-04-06 |