| NPI | 1700314101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 71193) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.134414) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125070701) | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2022-06-22 |