| NPI | 1912683186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2023022978) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: MO 2024022436) |
| Enumeration Date | 2023-06-23 |
| Last Update Date | 2024-07-03 |