| NPI | 1780028563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101264927) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 4149-320) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2025-09-26 |