| NPI | 1447633532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology Neuroradiology (Licence: ID M-17109) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: CA A167502) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 67899-20) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107050) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2023-03-09 |