| NPI | 1265743595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA MD.204718) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A136122) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2022-09-20 |