| NPI | 1255539326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A106513) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV LL1815) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2015-09-24 |