| NPI | 1891371373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085N0700X (Licence: OK 7750) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 7750) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2026-05-22 |