| NPI | 1972189793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101288819) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME159329) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-06-11 |