| NPI | 1760825442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2015-0702) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2013-0428) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2019-12-04 |