| NPI | 1003172891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: SC 52758) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A147247) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2018-09-18 |