| NPI | 1699302661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD493781) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-04-01 |