| NPI | 1124474259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A154223) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085B0100X Radiology, Body Imaging (Licence: CA A154223) | |
| Enumeration Date | 2016-05-07 |
| Last Update Date | 2022-12-13 |