| NPI | 1699298950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: SC 52756) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN24963) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-07-24 |