| NPI | 1205539244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A198428) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL L.5949) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2024-08-31 |