| NPI | 1023758018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A187863) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: CA A187863) |
| 208600000X Surgery (Licence: WA MDRE.ML.61292958) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2023-07-17 |