| NPI | 1861913790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 5675) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0116037505) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101027413) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037505) | |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2025-01-29 |