| NPI | 1063611275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60217663) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A107739) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2012-06-18 |