| NPI | 1306189188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD.60844932) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA MD.60844932) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-31 |
| Last Update Date | 2019-09-19 |