| NPI | 1962897298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60863) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 27404) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2020-08-06 |