| NPI | 1780950931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60484288) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML60286443) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML60286443) | |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2023-05-15 |