| NPI | 1134418759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 29211) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A142667) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2021-07-19 |