| NPI | 1902338387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 202201032) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 109821) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2025-10-02 |