| NPI | 1043940455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA PTL8644) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-07-23 |