| NPI | 1629397047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 52764) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TN 52764) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 244614) | |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2022-03-23 |