| NPI | 1861386559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2026025629) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND 22595) |
| Enumeration Date | 2025-06-06 |
| Last Update Date | 2026-06-09 |