| NPI | 1285884767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 12057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 12057) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2019-08-19 |