| NPI | 1700346673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 2986) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V1842) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-01-21 |