| NPI | 1699152801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL OS16636) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 3500) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-07-16 |