| NPI | 1194112516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60877016) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A173636) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 60561719) | |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2022-08-16 |