| NPI | 1740418631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA MD207772) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301095088) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2022-07-21 |