| NPI | 1689150401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A185070) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA MDRE.ML.60960928) |
| 207R00000X Internal Medicine (Licence: RI LP04446) | |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2026-01-19 |