| NPI | 1922502806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 89620) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TN 0000059293) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-05-02 |