| NPI | 1851892202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0102205748) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH R4579) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2025-06-02 |