| NPI | 1790164671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 31834) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S6675) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2021-07-08 |