| NPI | 1518126341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A117299) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A117299) |
| 208D00000X General Practice (Licence: VA 0101248213) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2021-08-02 |