| NPI | 1790149748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-05822) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 2917-321) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2025-09-26 |