| NPI | 1770901530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 82933) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101290101) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C6090) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 39250) | |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2026-10-01 |