| NPI | 1902105489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 83944) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 078159) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2023-03-08 |