| NPI | 1821361320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0102203622) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102203622) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2020-12-15 |