| NPI | 1740645035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101285597) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 94254) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2025-06-16 |