| NPI | 1790307494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2025-0537) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 187329) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2025-07-08 |