| NPI | 1316443823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A185545) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0006979) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2023-06-05 |