| NPI | 1841668308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160161) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D94366) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301108672) | |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2024-04-03 |