| NPI | 1841550316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 006222) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R2294) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101019892) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2024-01-16 |