| NPI | 1811308588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301501433) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2020-06-29 |