| NPI | 1992334122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: UT 14277761-1205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T5267) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-07-22 |