| NPI | 1780902841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301096654) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101284952) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61654673) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2025-09-03 |