| NPI | 1710208988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 076080) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-3691) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A117528) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2025-09-15 |