| NPI | 1134354079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: CA A139553) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 4207) | |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2020-03-13 |