| NPI | 1912392283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX R9006) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM R-22-2015) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AL DO.2173) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2025-08-05 |