| NPI | 1750735643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6893) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2021-02651) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2026-05-29 |