| NPI | 1710348644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A152786) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA A152786) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-20 |
| Last Update Date | 2021-08-12 |