| NPI | 1811525793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A200812) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-10-20 |