| NPI | 1821521576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 6460) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: GA 91425) |
| 208600000X Surgery (Licence: WA OL60766839) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2024-08-06 |