| NPI | 1861887671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 85025) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 39) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2020-06-25 |