| NPI | 1811330954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020020776) |
| Additional Taxonomies | 2085N0700X (Licence: CA 161916) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0443996) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2023-02-02 |