| NPI | 1962994517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10065927) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 94-09570) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2019-07-01 |