| NPI | 1952797565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NM MD2020-0543) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM NM RS2015-0513) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2024-09-23 |