| NPI | 1629411061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: CA A135516) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2020-10-21 |