| NPI | 1902256548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID O-1709) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 009081) |
| 208600000X Surgery (Licence: AZ R2701) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-07-08 |