| NPI | 1710369962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 257103) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P3-1994) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2022-04-20 |