| NPI | 1760914584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VT 042.0016968) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 390200000) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2023-07-18 |