| NPI | 1801246665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD049170) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MD049170) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301110460) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2021-06-22 |