| NPI | 1063878783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A15774) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.016514) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 34.16514) | |
| 208D00000X General Practice (Licence: CA pending) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 20A15774) | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2023-05-05 |