| NPI | 1861913790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037505) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5151013377) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0116037505) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2023-06-16 |