| NPI | 1255821120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A22502) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R3011) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.074472) | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2024-08-12 |