| NPI | 1770012411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: FL ME155688) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: CA A157520) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 271876) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2025-01-20 |