| NPI | 1679809537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A81088) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60120226) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2023-07-10 |