| NPI | 1861013146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22328) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 79014) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2026-07-30 |